Momentum is Building

With the revelation that the specialized support surface market was over $2 billion in 2011, and that it is growing fast, it is clear that more and more hospitals are making the required investment in pressure ulcer prevention.  Forty states now have requirements that hospitals report publicly the occurrence of medical errors, including Stage 3 and 4 pressure ulcers.  The NDF plans to do its part in aiding this trend, including a completely redesigned website and a new emphasis on fundraising.  Funds are needed to allow the NDF to accomplish its goal of public education regarding the extent and severity of the pressure ulcer problem in our hospitals.

2011 Review

Thanks to all who have supported the efforts of the National Decubitus Foundation during 2011.  The year began with the NDF presentation at the 12th NPUAP Biennial Conference in Las Vegas, with financial support from the Christopher and Dana Reeve Foundation.  There we were able to inform many of the leaders in bedsore prevention of the NDF Prevention Protocol, and to distribute many copies of the NDF prevention study.  The highlight for me was meeting Barbara Braden PhD, author of the Braden Scale, and hearing her agree that many hospitals have been able to drive their incidence rates to near zero by implementing the findings of the NDF study.

The best news of the year came from the National Database of Nursing Quality Indicators, sponsored by the American Nursing Association.  For the first time since the survey started in 1998 it showed a meaningful reduction in hospital-acquired pressure ulcer incidence.  Whereas the incidence for 2004 and 2006-2007 held steady a t 6.4%, 2010 showed a drop to 3.8% (2.7% excluding Stage 1 ulcers).

In April Medicare published, over American Hospital Association objections, the first hospital-specific patient safety data, including serious pressure ulcers, to be released nationally. Low-G Technologies announced a promising new mattress overlay based on a material used successfully for years to relieve pressure for fighter pilots on extended missions.

In a call to the office of Senator Bob Gordon, co-sponsor of the bill requiring New Jersey nursing homes to change all mattresses to pressure redistrbution types by April 2012, we learned that there has been no major resistance from nursing homes and that compliance with the law is expected.  We followed that by sending letters to chairs of senate health committees in all 49 other states informing them of the New Jersey law and urging them to do likewise.

In October a story in the Sacramento Bee described the backing of the California Hospital Association (CHA) for the efforts of several of its member hospitals that, in effect, implemented the NDF Prevention Protocol.  Several hospitals had greatly reduced pressure ulcer incidence by assessing risk for all admitted patients, and placing those at risk on special pressure redistribution mattresses.  During 2012 we will inform all state hospital associations of this action by the CHA, and urge them to adopt a similar policy position.

California Hospital Association Endorses NDF Prevention Protocol

The Califonia Hospital Association has undertaken a major initiative - Advancing Safe Patient Care.  As a part of that initiative, whether they realize it or not, the CHA has endorsed the methodology of the NDF Prevention Protocol.  As a key example of the reduction in pressure ulcer incidence being achieved, they cite the Sutter Health network of hospitals as having reduced pressure ulcer incidence by 86 percent:

"Enhanced screening practices that identify and respond to the needs of 'at-risk' patients"

"A $10 million investment in special pressure relieving mattresses and surfaces for all patient beds, including those in ER's and operating rooms, dagnostic imaging and patient transport gurneys."

These are the two essential elements of the NDF Prevention Protocol.  It is exciting to realize that this progress by the CHA provides us with a dramatic opportunity to contact hospital associations in every state to educate them about the progress being made in California.

Why Progress is Slow

A press release today by researchers at the University of Toronto expresses what many of us have realized for a long time.  It is very difficult to light a fire that gets the attention of the media when it comes to pressure ulcers:

'This slow uptake of quality improvements in pressure ulcer care in Ontario may be connected to the condition's low profile relative to other diseases. "It's one of those diseases that's kind of silent," said Prof. Murray Krahn, principal investigator on the study who is a Professor in the Department of Medicine and the Faculty of Pharmacy at U of T, and Director of THETA.

"Unlike HIV or breast cancer, there are no advocacy groups marching for pressure ulcers. The patients are seniors with co-morbidities and low mobility in long-term care," said Krahn.  Compounding the condition's visibility problem is that it doesn't belong to a particular clinical group. Patients are cared for by nurses, surgeons, infectious disease specialists, general practitioners and internists, so no one group is well-positioned to champion the cause effectively'.

It continues to amaze that the necessary investment in pressure redistribution surfaces would save hospitals a considerable amount, yet most have not made that investment.

Kinetic Concepts Inc. Sold for $5 Billion

KCI is the only manufacturer of the air-fluidized bed other than Hill-Rom that we know of.  About a week ago KCI was sold for 5 billion dollars.  KCI is the manufacturer of the AtmosAir support surface, one of those identified on the NDF website as having been proven effective in preventing pressure ulcers when used in conjunction with the NDF Prevention Protocol.  Hopefully the value of this sale indicates that a strong market for effective support surfaces is expected. 

Thoughts on NDF Website

The New Jersey law requiring all nursing homes to replace all mattresses with pressure redistribution types represents the greatest hope for ending the scourge of bedsores in our lifetime.  I am thinking of redoing the NDF website (decubitus.org) to concentrate on this factor, to convince other states to follow New Jersey's lead, to explain why the requirement must be extended to hospitals, and to raise funds to finance a campaign to educate the legislatures of 49 states.

Promising New Mattress Overlay

We have recently been contacted by Low-G Technologies, LLC.  They have developed a mattress overlay that has now undergone over 40,000 patient days of use without any hint of a pressure ulcer.  We will watch the progress of this product carefully.  This may be an ideal support suface for incorporation into the NDF Prevention Protocol.